Applebaum Allison J, Kulikowski Julia R, Breitbart William
Memorial Sloan Kettering Cancer Center,New York,New York.
Palliat Support Care. 2015 Dec;13(6):1631-41. doi: 10.1017/S1478951515000450. Epub 2015 May 22.
The multidimensional burden that results from providing care to a patient with cancer is well documented and a growing number of psychosocial interventions have been developed to address this burden. None, however, target existential distress, a critical, common element - and potentially driving mechanism - of caregiver burden. Meaning-Centered Psychotherapy (MCP) is a structured psychotherapeutic intervention originally developed by our group to target existential distress and spiritual well-being among patients with advanced cancer. We are currently developing Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C). The objective of this qualitative study is to describe the application of MCP to the unique experience of caregivers of patients with advanced cancer.
A case study of a participant from an initial MCP-C group is presented, with a focus on the application of sources of meaning to the cancer caregiving experience.
The exploration of critical sources of meaning in the participant's life generally, and related to caregiving specifically, highlighted significant areas of growth, including an increased understanding of the historical context shaping her experience of providing care, the recognition of the need for improved self-care and reconnecting with meaningful activities, and the possibility for continued connectedness to others and the world, despite the limitations resulting from her husband's terminal illness.
Existential distress is a critical and often overlooked element of burden among cancer caregivers. MCP-C is intended to target this component of burden and address this critical gap in the palliative care literature. Clinical trials are underway to evaluate the efficacy of MCP-C delivered over the Internet. Future studies are needed to evaluate the benefits of MCP-C for particularly burdened groups of caregivers, such as caregivers of patients with brain tumors and those undergoing hematopoietic stem cell transplantations, and to identify target points of delivery that will optimize the intervention's benefits.
为癌症患者提供护理所产生的多维度负担已有充分记录,并且已经开发出越来越多的心理社会干预措施来应对这一负担。然而,尚无针对存在性痛苦的干预措施,而存在性痛苦是护理者负担的一个关键、常见因素,并且可能是驱动机制。意义中心疗法(MCP)是我们团队最初开发的一种结构化心理治疗干预措施,旨在针对晚期癌症患者的存在性痛苦和精神健康。我们目前正在开发针对癌症护理者的意义中心疗法(MCP-C)。这项定性研究的目的是描述MCP在晚期癌症患者护理者独特经历中的应用。
介绍了一名来自初始MCP-C小组参与者的案例研究,重点是意义来源在癌症护理经历中的应用。
对参与者生活中关键意义来源的探索,特别是与护理相关的意义来源,突出了显著的成长领域,包括对塑造其护理经历的历史背景有了更多理解,认识到需要改善自我护理并重新参与有意义的活动,以及尽管其丈夫身患绝症带来诸多限制,但仍有可能与他人及世界保持持续联系。
存在性痛苦是癌症护理者负担中一个关键且常被忽视的因素。MCP-C旨在针对这一负担因素,并填补姑息治疗文献中的这一关键空白。目前正在进行临床试验,以评估通过互联网提供MCP-C的疗效。未来的研究需要评估MCP-C对特别负担沉重的护理者群体(如脑肿瘤患者的护理者和接受造血干细胞移植的患者的护理者)的益处,并确定能够优化干预效果的交付靶点。